Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a condition caused by mechanical interference with the median nerve in the wrist.

This large nerve provides feeling to the thumb, index and middle fingers and half of the ring finger. It also provides power to the small muscles at the base of the thumb.
Carpal Tunnel-A5
This diagram shows the median nerve being compressed in the carpal tunnel. The compression is relieved when the transverse carpal ligament is divided in carpal tunnel release.

The median nerve enters the hand from the forearm, passing beneath a tough ligament (known as the transverse carpal ligament) that runs across the wrist. For reasons that are poorly understood, this nerve can become squeezed, either because the contents of the tunnel beneath the ligament swell, or because the size of the tunnel decreases. This squeezing of the nerve causes tingling in the fingers, often accompanied by numbness. These sensations are usually worse at night, and often wake a patient from sleep. Pain can occur later on in the condition and can be felt in the hand, forearm or even in the upper arm and shoulder. 

What surgery is available, and what techniques are involved?

Surgery to treat Carpal Tunnel Syndrome is simple and generally effective. It involves dividing the carpal ligament to allow it to relax and relieve the pressure on the nerve. This can be done in a number of ways, and a surgeon will outline the course of action most suitable to you.

Splinting of the wrist and steroid injections are also available treatment options, but surgery is the most reliable.

What should I expect as a patient?

The operation usually only takes a few minutes, with a patient having a local anaesthetic and discharged immediately afterwards. All that is usually required is the application of a dressing over the short scar at the wrist.

The results of this operation are usually good. Pain is almost always immediately relieved, and the tingling also subsides. If the hand has been affected for a long time, the numbness may persist for many weeks, and any loss of muscle bulk that has occurred is unlikely to improve. 

As with all operations, procedures and outcomes vary from case to case. There can be occasional complications in Carpal Tunnel surgery, including unexpected bleeding, wound infection and lumpy or painful scars, but by and large this operation is simple, safe and highly successful.

The surgical treatment of Carpal Tunnel Syndrome is widely available on the NHS. 

Further information

BSSH- The British Society for Surgery of the Hand
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